Customer/Project Information Sheet
Date Received by SCE:
Individual or Business Name:
(Customer / Developer – Tract DBA or LLC )
Address:
Email Address:
City:
State:
Attn:
Phone No:
Legal Contact:
Phone No:
Zip Code:
(Individual responsible for signing contract, paying fees and receiving potential refunds)
Address:
Email Address:
City:
State:
Zip Code:
Primary Field / Site Superintendent / Job Contact:
Relationship to Project:
Phone No. (Direct Lines ONLY):
E-mail Address:
Fax No:
Project
FAX No:Address:
City:
State:
TG Map # or GPS:
Zip Code:
Major Cross Street:
Detailed Project Information
Residential:
Commercial:
Industrial:
Agricultural:
Service Requested:
Overhead:
Underground:
Indoor Cultivation
Tract:
Lot(s):
Mixed-Light Cultivation
Is this project subject to Buy America Compliance? Yes
No
Approximate start work date for SCE crews:
Temporary Service Required: Yes
No
Your Construction Start Date:
Approximate date you would like the job completed and energized:
Scope of Project:
Panel Size (amps):
Service Voltage/Phase:
Total Tons of A/C:
Total # of A/C Units:
Largest A/C Unit (tons):
Total HP of Pumps:
Total # of Pump Units:
Largest Pump (HP):
Installing Gas or Electric: Heater:
Clothes Dryer:
Water Heater:
Stove:
Gas Meter to be Installed at Property:
Oven:
Square Footage of Buildings (if multiple buildings give all footages):
Homes over 5000 sq. ft larger lots require a Load Schedule. Please contact your electrician for assistance.
Solar or Generation Equipment to be installed (If yes, please attach additional descriptions/specifications): Yes
Is this project being completed on or near a CalTrans Right Of Way (ROW):
04/19/2022 - Version 8.0
Page |1
Yes
No
No
DS-111
Electric Vehicle Charging - Mandatory. Please select one option.
I am interested in one of SCE’s Charge Ready EV Infrastructure programs.
• Complete Sections A and B below.
• Refer to Additional EV infrastructure program information or Submit a question.
I am interested in installing my residential EV project using Tariff Rules 15 and/or 16.
• Complete Section B below.
I am interested in installing my commercial EV project using Tariff Rules 15, 16, and/or 29.
• Please email tepmcommercialev@sce.com for additional submittal requirements.
Section A
Electric Vehicle
Passenger
• Refer to Additional Information or Submit a question
Medium/Heavy Duty
• Refer to Additional Information or Submit a question
Charge Station
Plug-In Electric Vehicle
(PEV)
Section B
EV Panel Size & Voltage:
Main breaker rating:
Will the new panel serve any load other than the EV load?
Number of Ports:
kW of each Port:
Future EV expansion or growth at the site?
04/19/2022 - Version 8.0
Will there be load-side management?
Page |2
DS-111